OBJECTIVE: To explore the anatomic feature and clinical application of the bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. METHODS: The anatomic features and distribution of upper muscular branches of lateral femoral muscle were observed in the lower extremities of 40 adult cadavers. From February 1989 to February 1999, 7 cases with bone defect or nonunion of upper part of femur were treated with transfer of bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. RESULTS: The upper muscular branches of lateral femoral muscle originated from the transversal branch of lateral circumflex femoral artery. The musculoperiosteal branch and periosteal branch were originated at 16.8 +/- 3.0 cm below the greater trochanter. The diameter and length of musculoperiosteal branch were 1.4 to 1.7 mm and 2.7 to 5.6 cm, those of the periosteal branch were 0.4 to 0.6 mm and 1.2 to 1.5 cm respectively. Bone union achieved in 10 to 18 weeks after operation in all 7 cases after 18 to 42 months follow-up. The motion of hip joint reached 180 degrees in 4 cases, 120 degrees in 2 cases and 65 degrees in 1 case. The donor area recovered well. CONCLUSION: The bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle is an effective alternative for repairing the bone defect or nonunion of the upper or middle part of femur.
Objective To discuss the effectiveness of antibiotic-impregnated cement temporary spacer for osteomyel itis and nonunion of bone caused by intramedullary fixation. Methods Between June 2002 and May 2006, 12 patients with chronic osteomyel itis and nonunion of bone caused by intramedullary nail ing were treated, including 8 males and 4 females with an average age of 40.2 years (range, 26-53 years). The fracture locations included tibia in 7 cases and femur in 5cases. Infection occurred within 2 weeks after intramedullary fixation in 7 cases and within 3 months in 5 cases. The mean time from infection to admission was 5 months (range, 1-24 months). The results of bacteria culture were positive in 10 cases and negative in 2 cases. White blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were higher than normal values. An antibiotic-impregnated cement temporary spacer was inserted after removal of biomembrane and internal fixator, thorough debridement and irrigation. After osteomyel itis was controlled by antibiotic therapy postoperatively, two-stage bone transplantation and internal fixation were performed after 3 to 6 months. Results All wounds healed by first intention without early compl ication. All cases were followed up 24 to 48 months (mean, 34 months). WBC count, ESR, and CRP were normal at 3 months postoperatively. The X-ray films showed the fracture heal ing at 10-14 weeks after operation (mean, 12 weeks). Expect one patient had knee range of motion of 90°, the lower l imb function of the others returned to normal. No infection recurred during follow-up. Conclusion Antibiotic-impregnated cement temporary spacer could control osteomyelitis and nonunion of bone caused by intramedullary nail ing, and two-stage bone transplantation and internal fixation after osteomyelitis is an effictive and ideal way to treat osteomyelitis and nonunion of bone caused by intramedullary nail ing.
To evaluate the initial cl inical effect of the autologous bone marrow integrating artificial bone and il ium periosteum transplantation in treatment of problematic nonunion. Methods From January 2004 to July 2006, 12 patients (13 l imbs)with problematic nonunion were treated with autologous bone marrow integrating artificial bone and il iumperiosteum. There were 8 males and 4 females, aged 17-58 years old. The position of nonunion were the tibia in 7 l imbs, the femur in 3 l imbs, the humerus in 2 l imbs. The operated number was 1-4, mean 2.5. The time from injury to therapy was 13 months to 9 years, mean 47.6 months. The bone defect distance was 6-30 mm (mean 15 mm) through 1 ∶ 1 X-rays before operation. Eleven l imbs were treated by internal fixation (10 l imbs by the bone nail and 1 l imb by the l imited contact-dynamic compression plate), 2 l imbs were treated by the external fixation. The X-ray films were taken at 1 day, 1, 3, 6, 9, 12 months after operation to observe fracture union. Results All patients were followed up for 12-26 months (mean 17.5 months) and achieved union within 4-7 months (mean 6 months). No deformity of rotation, angulation and crispation occurred in 13 l imbs, but functional impairment occurred in 6 l imbs after union of fracture. Conclusion Autologous bone marrow integrating artificial bone and il ium periosteum transplantation for treatment of problematic nonunion has the satisfactory result.
Objective To explore the cl inical effects of different operative procedures in treatment of upper humerus fracture nonunion. Methods From May 2001 to September 2007, 43 cases of upper humerus fractures nonunion were treated, including 31 males and 12 females with an average age of 37 years (range, 20-57 years). The causes were trafficaccident injury in 14 cases, fall ing injury from height in 11 cases, tumbl ing injury in 7 cases, heavy pound injury in 6 cases, machine injury in 4 cases, and pathological injury in 1 case. The time from fracture to hospital ization was 10-52 months (23 months on average). After open reduction, patients were treated respectively by bone-graft plus locking compression plate fixation (9 cases), scapula flap rotation displacement plus locking compression plate fixation (15 cases), and scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation (19 cases). Results All incisions healed by first intention. The X-ray films showed good fracture reduction. No symptoms of infection and nerve injury occurred. Forty-three patients were followed up 12 to 25 months with an average of 18 months. All of them achieved radiographic union within 3.0 to 7.5 months (4.9 months on average). According to comprehensive assessing standard of X-ray film and functions of shoulder and elbow, the results were excellent in 21 cases, good in 15 cases, fair in 4 cases, and poor in 3 cases; the excellent and good rate was 83.7%. Conclusion In the treatment of upper humerus fractures nonunion, locking compression plate can provide stable fixation. It can achieve satisfactory results so long as the right method of bone graft is chosen according to fracture site situation. But for patients undergoing repeated surgery or having nonunion for long times and poor fracture site situation, after open reduction, scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation has good outcome.
ObjectiveTo investigate the surgical procedures and results of nonunion of lateral humeral condyle fracture combined with cubitus valgus. MethodsBetween January 2006 and September 2011, 19 cases of nonunion of lateral humeral condyle fracture combined with cubitus valgus were treated with supracondylar closing wedge osteotomy, open reduction, autogenous bone grafting, and internal fixation. There were 11 males and 8 females, aged 14-28 years (mean, 21.6 years). The left side was involved in 7 cases, and the right side in 12 cases. The disease duration was 3-22 years (mean, 9 years). The osseous protuberance and enlargement were seen in the lateral condyle of all the cases, with cubitus valgus. Compared with the contralateral side, the angle of cubitus valgus deformity increased (34.00±7.68)° at the affected side. The elbow range of motion of flexion and extension was (117.35±19.77)° in the other 17 patients except 2 patients with joint stiff. Among them, 10 patients had limited mobility. Three patients had ulnar neuritis. ResultsAll the patients obtained primary healing of incision, and no surgery-related complication occurred. Nineteen patients were followed up 2-6 years (mean, 3.2 years). Bony union at lateral condylar fracture site and the supracondylar osteotomy site was achieved in all cases within 6 months postoperatively. In 3 patients with ulnar neuritis, the symptoms of nerve injury disappeared within 6 months. At last follow-up, the angle of cubitus valgus deformity increased (3.21±4.09)° at the affected side when compared with the contralateral side, showing significant difference when compared with preoperative angle (t=30.472, P=0.000). The range of motion of the elbow was 20° and 30° in 2 patients with joint stiff before operation; the elbow range of motion of flexion and extension was (117.64±15.72)° in the other 17 patients, showing no significant difference when compared with preoperative value (t=-0.180, P=0.859). According to the appearance of the elbow, range of motion, and complications, the overall results were classified as excellent in 9 patients, good in 8 patients, and poor in 2 patients; the excellent and good rate was 89.5%. ConclusionSupracondylar closing wedge osteotomy can correct the cubitus valgus deformity and improve the symptoms of ulnar neuritis. Open reduction, autogenous bone grafting, and internal fixation for nonunion of the lateral condyle can effectively stabilize the lateral condylar fracture and promote fracture healing.
Objective To report the clinical outcome of the transposition of the radial styloid bone flap pedicled on the recurrent branch of the radial artery in the treatment of scaphoid nonunion. Methods From March 2000 to June 2005,the procedure was done in 18 patients with scaphoid nonunion, a small bone flap(1.5 cm×3.5 cm×0.5 cm) pedicled on the recurrent branch of radial artery to the styloid process was raised from the radial styloid process and grafted into the corresponding slot chiseled along the vertical axis of scaphoid crossing the fracture line. Of 18 patients, 15 were males and 3 were females, aging 18-39 years. The locations were lumbar scaphoid in 11 patients and proximal scaphoid in 7 patients,among whom 5 had presented avascular necrosis in the proximal fragments of the scaphoid. Pain occurred in the act of wrist motion, and became obvious in the case of dorsiextension and radial deviation. Compression pain was observed in the stuff nest. The wrist joint activity is subjected to limit. The X-ray showed hardening and cystic degereration at fracture end and obviously widening fracture line. Results The scaphoid fracture healed in all 18 cases, the 5 proximal scaphoid fracture fragments which had previously been necrosed survived, a mean healing time of scaphoid was4 months. A follow-up of 1 to 5 years revealed normal wrist motion without pain in all cases. The life and job was good every day. Conclusion Transposition of the bone flap pedicled on the recurrent branch of the radial artery to the scaphoid is relatively simple and can effectively treat scaphoid nonunion and avascular necrosis with a great value in clinical application.
OBJECTIVE To investigate the effect of percutaneous bone marrow graft for the management of nonunion of tibia. METHODS From March 1996 to June 2000, 56 cases with nonunion of tibia were treated by autogenous bone marrow graft. Among them, there were 38 males and 18 females, aged from 19 to 72 years. A marrow needle was inserted into the site of the nonunion under the X-ray, the autogenous bone marrow was injected into the site of nonunion. Compression bandage and appropriate immobilization material were applied after operation. This procedure was repeated every month, 2 or 3 times was needed. RESULTS 56 patients were followed-up for 4 months to 4 years and 2 months, averaged 2.8 years. Fracture healed in 53 cases and X-ray displayed fracture line disappeared and a great deal of continuous callus formed, and nonunion in 3 cases. CONCLUSION Percutaneous autogenous bone marrow graft can play a role in osteogenesis at the site of nonunion. It is easy to aspirate bone marrow and the operation is simple. It has clinical application value for the satisfactory effect.
ObjectiveTo explore the effectiveness and method of Ilizarov technology for the treatment of infected forearm nonunion. MethodsBetween January 2004 and March 2014, 19 patients with infected forearm nonunion were treated, including 12 males and 7 females with a mean age of 37.4 years (range, 18-62 years). The injury causes included traffic accident in 11 patients, falling from height in 4 patients, and machine twist injury in 4 patients. The patients had received surgical treatment for 1-5 times (mean, 2.7 times). Bone defects located at the radius in 10 cases, at the ulna in 7 cases, and at the radius and ulna in 2 cases. The mean time of chronic infection was 8.3 months (range, 4-16 months). The mean length of the bone defects after debridement was 3.54 cm (range, 2.2-7.5 cm). Under the guidance of C-arm fluoroscope, the Orthofix unilateral external fixator was used to fix. Distraction was performed at 7-10 days after operation, and X-ray film was taken regularly to detect the osteogenesis. ResultsThe mean external fixation time was 6.5 months (range, 3-12 months), and the mean external fixation index was 1.72 months/cm (range, 1.14-2.15 months/cm). All patients were followed up for 35.4 months on average (range, 24-55 months). The bone union time was 3-11 months (mean, 6 months); and no recurrence of infection was observed. At last follow-up, the mean wrist range of motion (ROM) were 52.78° (range, 42-55°) in flexion and 46.53° (range, 40-60°) in extension; the mean elbow ROM were 139.23° (range, 130-150°) in flexion and 3.57° (range, 0-20°) in extension; and the mean forearm ROM were 76.68° (range, 68-90°) in pronation and 81.75° (range, 72-90°) in supination. ConclusionIlizarov technology for infected forearm nonunion can acquire satisfactory clinical results. Radical debridement is the key to control bone infection.
Clinically, fracture nonunion often leads to pain and disability in patients. Fracture nonunion often requires additional surgery to restore skeletal muscle function, so the treatment of fracture nonunion has always been a difficult point in the field of orthopedics. In recent years, with the development of genetic engineering, the technology of using gene to treat fracture nonunion has been widely studied. A large number of experiments have confirmed that the target genes encoding growth factors related to fracture healing are introduced into target cells through different delivery methods in vivo or in vitro, thereby expressing specific growth factors can promote fracture healing, which provides a new way for treating fracture nonunion. This article will discuss the research status of different delivery methods of osteogenic genes, as well as their advantages and disadvantages, in order to provide a theoretical basis for targeted gene therapy for fracture nonunion.
Objective To investigate the effectiveness of tunnel osteogenesis technique combined with locking plate in the treatment of aseptic non-hypertrophic nonunion of femoral shaft. MethodsThe clinical data of 23 cases of aseptic non-hypertrophic nonunion of femoral shaft treated with tunnel osteogenesis technique combined with locking plate between January 2017 and December 2020 were retrospectively analysed. There were 17 males and 6 females with an average age of 41.4 years (range, 22-72 years). There were 22 cases of closed fracture and 1 case of open fracture. The types of internal fixation at admission included intramedullary nail in 14 cases and steel plate in 9 cases. The number of nonunion operations received in the past was 0 to 1; the duration of nonunion was 6-60 months, with an average of 20.1 months. Among them, there were 17 cases of aseptic atrophic nonunion of the femoral shaft and 6 cases of dystrophic nonunion. Twenty-two cases were fixed with 90° double plates and 1 case with lateral single plate. The operation time, theoretical blood loss, hospitalization stay, nonunion healing, and postoperative complications were recorded. Harris hip function score, Lysholm knee function score, lower extremity function scale (LEFS), and short-form 36 health survey scale (SF-36) were used at last follow-up to evaluate hip and knee functions. Visual analogue scale (VAS) score was used to evaluate the relief of pain at 1 day after operation and at last follow-up. ResultsThe average operation time was 190.4 minutes, the average theoretical blood loss was 1 458.4 mL, and the average hospitalization stay was 8.2 days. All the 23 patients were followed up 9-26 months, with an average of 18.2 months. The healing time of nonunion in 22 patients was 3-12 months, with an average of 5.6 months. There were 8 cases of limb pain, 8 cases of claudication, 6 cases of limitation of knee joint movement, and 2 cases of limitation of hip joint movement. At last follow-up, the imaging of 1 patient showed that the nonunion did not heal, accompanied by pain of the affected limb, lameness, and limitation of knee joint movement. At 1 day after operation, the VAS score of 23 patients was 6.5±1.8, the pain degree was good in 7 cases, moderate in 12 cases, and poor in 4 cases; at last follow-up, the VAS score was 0.9±1.3, the pain degree was excellent in 21 cases and good in 2 cases, which were significantly better than those at 1 day after operation (t=12.234, P<0.001; Z=–5.802, P<0.001). At last follow-up, the average Harris hip function score of 22 patients with nonunion healing was 94.8, and the good rate was 100%; Lysholm knee function score averaged 94.0, and the excellent and good rate was 90.9%; LEFS score averaged 74.6; SF-36 physical functioning score averaged 85.0 and the mental health score averaged 83.6. ConclusionTunnel osteogenesis technique combined with locking plate in the treatment of aseptic non-hypertrophic nonunion of femoral shaft has a high healing rate and fewer complications, which can effectively relieve pain and improve lower limb function and quality of patients’ life.